Expert Discusses Therapeutic Options Taken At Home During COVID-19 Pandemic

As the novel coronavirus (COVID-19) has impacted many patients and their care during the pandemic, those with ovarian cancer have oral therapeutics as a treatment option to help them stay safe at home, according to Dr. Jubilee Brown.

“COVID has affected all of us, caregivers and patients alike. And that's changed a lot. At first, it was a lot of anticipation and fear around patients’ anxiety over how this would affect them and their care. And now, just in the span of a few months, we know a lot more about how COVID works. And we have very thoughtful policies and recommendations over how to best care for patients. So, I think there's a lot less fear and anxiety now, and a lot more structure of what we need to do,” she explained in an interview with CURE®.

Brown, from Atrium Health in Charlotte, North Carolina, discussed the use of telemedicine and oral treatment options for patients with ovarian cancer, as well as offered advice to ease stress and anxiety throughout the COVID-19 pandemic.

CURE: Can you discuss how telemedicine has played a role in helping patients with gynecologic cancers through this entire pandemic?

Brown: I think we've all adopted telemedicine where it's been appropriate and that serves really two purposes. It keeps people safe when there's a high prevalence of COVID. So, it allows patients who may be immunosuppressed and potentially more at risk, if they were to catch COVID, it allows them to get care at home. And secondly, it really allows us to continue care when we're trying to limit the number of patients and allow social distancing. So, most caregivers across the country now use telemedicine in some aspect of their care.

We adopted this at the beginning of the pandemic. We do a lot of our chemotherapy clearances, a lot of our follow ups using telemedicine, whether it's a video or just a phone platform. And in general, I think it works well.

I think there are some limitations to it. It is a little bit different in terms of that interpersonal interaction. But it certainly is a great way to deliver good care and also to screen patients so that if there is a problem, then you can say we really do need to see each other face-to-face or mask-to-mask.

What are some options that patients with ovarian cancer have for treatment at home?

We've certainly migrated a lot to oral therapies. PARP inhibitors, specifically, are really important considerations, especially during this pandemic. So, we know that many patients with ovarian cancer benefit from PARP inhibitors, whether it's frontline, or whether it's in the recurrent setting. And we've known this now for some time. It's also not just limited to patients who have BRCA mutations. Certainly, it's patients who are platinum sensitive. And so, I think that based on a lot of the studies, we know that PARP inhibitors are effective in all these settings. We've transitioned, certainly, where in the past, we may have reserved PARP inhibitors for later (lines of treatment).

PARP inhibitors are all oral. Patients can take those oral drugs at home and have very active treatment for their cancers. It allows them to stay out of the medical setting. It allows them to be safe and still get effective therapy. And with the use of telemedicine, we can follow up with them as often as we need to, to check on them and make sure that they're doing well on their therapy.

Is this similar in the maintenance setting?

Absolutely. We've had several different options in terms of maintenance therapy. But certainly, PARP inhibitors are playing an increasing role in the maintenance setting. And again, that's for patients who have BRCA mutations as well as all comers (everyone who has a diagnosis of ovarian, tubular or peritoneal cancer) should at least consider the use of PARP inhibitors in the maintenance setting at this point.

What is the importance of making sure that patients are keeping up with their treatment regimen on oral agents?

So, medications only work if you take them. We have to be really vigilant about making sure that patients keep on the recommended dose and frequency. Patients should keep in close contact with their physician so that we can manage any side effects that might crop up. And so, some of those things like nausea, patients might get nausea on a PARP inhibitor, but we can treat that. It's really important to keep in touch with your doctor or doctor's office so that we can take care of those side effects so that patients can stay on that medicine. It is the same thing in terms of lab values. It's really important to stay up on those lab values so that we can sometimes alter the dose or the scheduling frequency so that patients can stay on the most effective regimen.

If patients have concerns about their treatment, or having to visit their physician during the pandemic, what is some advice you can offer to calm down some of their stress or anxiety?

In our practice and hospital, we know a lot more about how this virus works now than we used to. And we are taking extreme precautions to make sure that patients are as safe as possible…Every time when I walk into the hospital, I have to be masked. I have to wear my fancy eyewear. I get my temperature screened and I have screening questions. Every caregiver who walks into the hospital is screened and is protected from spreading any virus. So basically, there is no virus in and no virus out. We are very careful with patients. And patients also wear a mask in the hospital, and we're careful with socially distancing there.

We keep a very close eye on proximity to other people. So, we do not overload our clinics or labs, really any area of the hospital, and we've limited visitors. That's really hard for patients a lot of the time when they're undergoing surgery, but we're doing absolutely everything we can to keep our patients safe when they're in the hospital, or even when they come to the clinic or the doctor's office. At this point, we are all taking so many safety measures to keep our patients safe that our patients should feel very confident that they are going to be safe when they come to the hospital.

What is your biggest piece of advice for a patient with a gynecologic malignancy?

Don't compromise on your therapy. We will keep you safe during your treatment. And we have lots of ways to do that. We have ways to keep you safe as you visit the doctor's office or the clinic or the hospital and we have a lot of ways that we can continue your treatment safely, a lot of times with modifications, so that you can take oral agents at home.